Short-Term Effects of Spinal Manipulation on H-Reflex Amplitude in Healthy and Symptomatic Subjects

Suter, Esther; McMorland, Gordon

doi:10.1016/j.jmpt.2005.09.017

Cited by 42 publications

(30 citation statements)

References 11 publications

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“…26,28,33,45,47,67,69,79,[89][90][91] Furthermore, and in reference to the improved deep cervical flexor motor performance found in our study, it has been hypothesized that HVLA thrust manipulation might stimulate receptors in the deep paraspinal musculature and nonthrust mobilization might be more likely to facilitate receptors in the superficial muscles. …”

Section: Changes In Deep Cervical Flexor Motor Performancementioning

confidence: 54%

Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial

Dunning¹,

Cleland²,

Waldrop³

et al. 2012

J Orthop Sports Phys Ther

131

110

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A pproximately 54% of individuals have experienced neck pain within the last 6 months, 24 and the incidence of neck pain may be increasing. 76 The economic burden associated with the management of patients with neck pain is high, second only to low back pain in annual workers' compensation costs in the United States. 98Two recent clinical prediction rules 17,21,22,81 have been developed in an attempt to guide treatment selection for patients with neck pain. However, one has yet to be validated and only identifies those patients with neck pain likely to benefit from cervical traction, 81 and the other, which attempted to identify those patients with neck pain likely to benefit from thoracic manipulation and a general cervical range-of-motion (ROM) exer- T T METHODS:Patients completed the Neck Disability Index, the numeric pain rating scale, the flexion-rotation test for measurement of C1-2 passive rotation range of motion, and the craniocervical flexion test for measurement of deep cervical flexor motor performance. Following the baseline evaluation, patients were randomized to receive either HVLA thrust manipulation or nonthrust mobilization to the upper cervical (C1-2) and upper thoracic (T1-2) spines. Patients were reexamined 48-hours after the initial examination and again completed the outcome measures. The effects of treatment on disability, pain, C1-2 passive rotation range of motion, and motor performance of the deep cervical flexors were examined with a 2-by-2 mixed-model analysis of variance (ANOVA). T T RESULTS:One hundred seven patients satisfied the eligibility criteria, agreed to participate, and were randomized into the HVLA thrust manipulation (n = 56) and nonthrust mobilization (n = 51) groups. The 2-by-2 ANOVA demonstrated that patients with mechanical neck pain who received the combination of upper cervical and upper thoracic HVLA thrust manipulation experienced significantly (P<.001) greater reductions in disability (50.5%) and pain (58.5%) than those of the nonthrust mobilization group (12.8% and 12.6%, respectively) following treatment. In addition, the HVLA thrust manipulation group had significantly (P<.001) greater improvement in both passive C1-2 rotation range of motion and motor performance of the deep cervical flexor muscles as compared to the group that received nonthrust mobilization. The number needed to treat to avoid an unsuccessful outcome was 1.8 and 2.3 at 48-hour follow-up, using the global rating of change and Neck Disability Index cut scores, respectively. T T CONCLUSION:The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than nonthrust mobilization in patients with mechanical neck pain. T T LEVEL OF EVIDENCE:Therapy, level 1b.

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Section: Changes In Deep Cervical Flexor Motor Performancementioning

confidence: 54%

Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial

Dunning¹,

Cleland²,

Waldrop³

et al. 2012

J Orthop Sports Phys Ther

131

110

View full text Add to dashboard Cite

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“…Of particular interest to the RI model are the effects of spinal manipulation on distal neuromuscular function. Suter et al 59,60 has demonstrated that thrust manipulation of the sacroiliac joint decreased motor inhibition of the knee extensor muscles, while Dishman et al 61 showed that lumbar spinal manipulation increased electromyographic (EMG) activity remotely in the gastrocnemius muscle. Additionally, Murphy et al 62 and Dishman et al 61,63 showed that manipulation of the lumbosacral region has the potential to produce a decrease in distal neuromuscular function as measure by the magnitude of the tibial nerve H-reflex.…”

Section: Proposed Mechanismsmentioning

confidence: 99%

“…These studies may be reflective of an interventional effect on nerve and muscular function beyond the immediate and adjacent regions of the body. While the evidence supporting a neurophysiological relationship between lumbosacral manipulation and remote lower extremity neurophysiological responses exists, a recent follow-up study by Suter et al 59 has suggested that manipulation may not have a significant effect on distal motoneuron excitability (H-reflex testing). It is unclear whether these studies refute the previous studies, are indicative of the variability normally seen when utilizing Hreflex as an outcome measure, or whether magnitude and direction of response are preferentially influenced.…”

Section: Proposed Mechanismsmentioning

confidence: 99%

A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications

Sueki

Cleland

Wainner

2013

Journal of Manual & Manipulative Therapy

135

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The term 'regional interdependence' or RI has recently been introduced into the vernacular of physical therapy and rehabilitation literature as a clinical model of musculoskeletal assessment and intervention. The underlying premise of this model is that seemingly unrelated impairments in remote anatomical regions of the body may contribute to and be associated with a patient's primary report of symptoms. The clinical implication of this premise is that interventions directed at one region of the body will often have effects at remote and seeming unrelated areas. The formalized concept of RI is relatively new and was originally derived in an inductive manner from a variety of earlier publications and clinical observations. However, recent literature has provided additional support to the concept. The primary purpose of this article will be to further refine the operational definition for the concept of RI, examine supporting literature, discuss possible clinically relevant mechanisms, and conclude with a discussion of the implications of these findings on clinical practice and research.

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“…5,6,19,38,39,50,51,62,63,68 Previous studies have used functional magnetic resonance imaging (fMRI) to measure hemodynamic displacement to structures within the brain over time, serving as a local measure of cognitive, sensory, or motor processes. 12,28,35,40 With this method, functional images are overlaid atop higher-resolution anatomic images, allowing inferences to be made regarding neural activity within the brain.…”

Section: T T Conclusionmentioning

confidence: 99%

Using Functional Magnetic Resonance Imaging to Determine if Cerebral Hemodynamic Responses to Pain Change Following Thoracic Spine Thrust Manipulation in Healthy Individuals

Sparks

Cleland

Elliott³

et al. 2013

J Orthop Sports Phys Ther

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[ research report ] R ecently, in the physical therapy profession con siderable attention has been devoted to exam ining the effectiveness of spinal manipulation in clinical practice. 9,15,16,24,65 The use of thrust manipulation applied to the thoracic spine has been shown to result in increased range of motion, decreased pain, and improvements in function in subgroups of individuals with mechanical neck and shoulder pain. [13][14][15][16]23,43,62,65 Biomechanical theories to explain the effects of spinal manipulation exist, yet the available data do not sufficiently explain how manipulation results in short-or long-term clinical benefits. 20,34,47,56 Researchers have attempted to identify which combination of clinical signs, symptoms, and other pertinent findings from the examination may predict a favorable response to spinal manipulation. 13,43,57 A validation study of a proposed clinical decision rule to identify patients likely to respond to thoracic manipulation found that subjects with mechanical neck pain improved with T T STUDY DESIGN: Case series. T T OBJECTIVES:To use blood oxygenation leveldependent functional magnetic resonance imaging (fMRI) to determine if supraspinal activation in response to noxious mechanical stimuli varies preand post-thrust manipulation to the thoracic spine. T T BACKGROUND:Recent studies have demonstrated the effectiveness of thoracic thrust manipulation in reducing pain and improving function in some individuals with neck and shoulder pain. However, the mechanisms by which manipulation exerts such effects remain largely unexplained. The use of fMRI in the animal model has revealed a decrease in cortical activity in response to noxious stimuli following manual joint mobilization. Supraspinal mediation contributing to hypoalgesia in humans may be triggered following spinal manipulation. T T METHODS: Ten healthy volunteers (5 women, 5men) between the ages of 23 and 48 years (mean, 31.2 years) were recruited. Subjects underwent fMRI scanning while receiving noxious stimuli applied to the cuticle of the index finger at a rate of 1 Hz for periods of 15 seconds, alternating with periods of 15 seconds without stimuli, for a total duration of 5 minutes. Subjects then received a supine thrust manipulation directed to the midthoracic spine and were immediately returned to the scanner for reimaging with a second delivery of noxious stimuli. An 11-point numeric pain rating scale was administered immediately after the application of noxious stimuli, premanipulation and postmanipulation. Blood oxygenation level-dependent fMRI recorded the cerebral hemodynamic response to the painful stimuli premanipulation and postmanipulation. T T RESULTS:The data indicated a significant reduction in subjects' perception of pain (P<.01), as well as a reduction in cerebral blood flow as measured by the blood oxygenation level-dependent response following manipulation to areas associated with the pain matrix (P<.05). There was a significant relationship between reduced activation in the insular cortex and d...

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Short-Term Effects of Spinal Manipulation on H-Reflex Amplitude in Healthy and Symptomatic Subjects

Cited by 42 publications

References 11 publications

Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial

Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial

A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications

Using Functional Magnetic Resonance Imaging to Determine if Cerebral Hemodynamic Responses to Pain Change Following Thoracic Spine Thrust Manipulation in Healthy Individuals

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